Diagnosis Of Acute Appendicitis Research Articles

Prospective Assessment of Elevated Serum Bilirubin in Diagnosis of Acute Appendicitis

Prospective Assessment of Elevated Serum Bilirubin in Diagnosis of Acute Appendicitis

Diagnostic value of procalcitonin, C-reactive protein and leukocyte count in detecting acute appendicitis in paediatric patients - a single center experience.

To evaluate diagnostic reliability of accessible laboratory findings in recognition of acute appendicitis (AA). A retrospective study included children aged 0-15 years with abdominal pain that lasted less than 5 days with at least two of the signs/symptoms - abdominal pain, tenderness of the lower right quadrant of the abdomen, "return" sensitivity of the abdomen to palpation, loss of appetite, nausea, vomiting, body temperature >37.2°C. Values of procalcitonin (PCT), C-reactive protein (CRP) and the leukocyte count were analyzed in the peripheral blood. Among 114 children, 63 (58.2%) were boys and 50 (41.8%) girls; median age of 9.5 years. Elevated values of PCT were found in 74 (65.5%), CRP in 94 (83.1%), and leukocytes in 78 (69%) (65%) children. Almost uniform significance in the recognition of AA was found for pathological values of PCT and CRP with sensitivity of 65% and 83% and diagnostic accuracy of 63% and 59%, respectively, but somewhat lower sensitivity for leukocytes, 61%. A very high predictive value of 98% for PCT and CRP, and PCT with leukocytes was found; CRP with leukocytes had a negative predictive value of 100%. PCT values have significant sensitivity, specificity and diagnostic accuracy in recognizing AA, while CRP and leukocytes, with high sensitivity, as non-specific markers can be a significant support for clinical assessment in the timely diagnosis of AA.

A comparative study of Appendicitis inflammatory response (AIR) score with Alvarado score in diagnosis of acute appendicitis at KCMC Hospital

Background: Acute appendicitis is an acute inflammation of the appendix, most resulted from obstruction of the lumen of the appendix. It is one of the most common causes of acute abdomen. Although a very common and long-known phenomenon, appendicitis remains a diagnostic challenge for most surgeons. Objective: To compare the validity of Appendicitis Inflammatory Response Score with Alvarado score in diagnosis of acute appendicitis at KCMC Hospital. Methods: A prospective hospital based cross sectional study done over a period of six months (September 2016 to March 2017). Patients were admitted to general surgical ward after the diagnosis of acute appendicitis reached and all parameters included in the AIR score and Alvarado score were prospectively recorded on patients presenting symptoms of acute appendicitis. All removed appendix specimens were sent for histopathological examination. Data was entered and analyzed using statistical package of social sciences version 20. Results: A total of 35 patients enrolled in this study, 57% male, male to female ratio 1.3:1, mean age of 27(14-49) years. 31 patients confirmed histologicaly to have features of acute appendicitis, among these inflamed appendicitis were 51.6%. And advanced appendicitis 48.4% and negative appendicectomy rate was 11.4%. The sensitivity and specificity of both AIR and Alvarado score were 54.4%, 77.4% and 75%, 75%. PPV and NPV were 94.4%, 96% and 17.6%, 30% respectively. Conclusion: From our study we have seen Alvarado score is a better assessment tool that is accurate helping in diagnosis of acute appendicitis. Its high sensitivity and ROC is greater than that of the AIR score. We conclude that AS has outperform AIR score in accuracy in diagnosis of AA.

Diagnostic Accuracy of C-Reactive Protein in Acute Appendicitis

Objective: To determine diagnostic accuracy of C-reactive protein in acute appendicitis. Study Design: Cross-sectional study. Place and Duration of Study: Surgical unit Combined Military Hospital Gujranwala Pakistan, from Apr 2019 to Jan 2021. Methodology: One hundred and twenty patients were included in the study following the inclusion criteria after their written permission and willingness. C-reactive protein levels were sent pre-operatively to the Pathology department of Combined Military Hospital Gujranwala. Patients were operated on by two classified surgeons. After open and laparoscopic appendectomies, specimens were sent to Histopathologists at Armed Forces Institute of Pathology Rawalpindi. Results were compared to determine the diagnostic accuracy of C-reactive protein. Results: Out of 120 patients, 72(60%) were males and 48(40%) were females. The diagnostic accuracy of C-reactive protein in acute appendicitis was calculated by keeping tissue diagnosis histopathology as the gold standard, where 82(68.33%) were true positive, 7(5.84%) were false positive, 13(10.83%) were true negative, and 18(15%) were false negative. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 89.13%, 67.86%, 90.11%, 65.52% and 84.17% respectively. Conclusion: The of C-reactive protein level test for the diagnosis of acute appendicitis was very sensitive but not very specific. C-reactive protein levels should be measured routinely in suspected cases of acute appendicitis, along with Total Leucocyte Count and ultrasound abdomen, as a useful marker for early diagnosis, thus reducing negative appendectomy rates.

A Comparison of the Alvarado Score and the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) Score in the Diagnosis of Acute Appendicitis: A Prospective Cohort Study.

Background Diagnosing acute appendicitis remains a problem, especially in teenagers with right lower quadrant pain.Imaging studies aid in accurate diagnosis but have limitations such as cost and availability. The Modified Alvarado Scoring System (MASS) is simple and cost-effective with fewer parameters. The Raja Isteri Pengiran Anak Saleha Appendicitisscoring system (RIPASA), designed for Asian populations, includes more parameters. This study compares the effectiveness of RIPASA and Alvarado scores in diagnosing acute appendicitis in a specific clinical setting. Objectives To compare the scoring systems of RIPASA and Alvarado in the diagnosis of acute appendicitis at a tertiary care hospital. Methods Data has been collected from all patients who attended the NRI general hospital emergency department and outpatient wing with acute appendicitis, admitted as inpatients based on clinical history and relevant investigations. Patients satisfying inclusion and exclusion criteria were selected and the basic investigations were done. Summary statistics were done using mean, standard deviation and proportions. Inferential statistics were done by using an independent t-test, kappa statistic, sensitivity and specificity with a 95% confidence interval (CI). All the measurements are done using the statistical package for the social sciences (SPSS) software version 21.0 (IBM Corp., Armonk, NY, USA) and open epidemiological (OpenEpi) software 3.01. A probability (p) <0.05 is considered as statistically significant. Results A total of 110 patients were analyzed for this study with a majority (39%) of them in the 21-30 age group. In our study, females (53%) outnumbered males (47%). Ultrasound findings in our cohort were acute appendicitis (93%), chronic appendicitis (2%) and normal appendix (5%). However, histopathology reported acute appendicitis (75%), chronic appendicitis (9%) and negative/non-specific (15%). The probability of appendicitis as predicted by Alvarado and RIPASA were 40% and 51% respectively. Definitive diagnosis of appendicitis was made in 16.4% with RIPASA whereas only 5.5% with Alvarado. When comparing the Alvarado and RIPASA scores, the sensitivity or true positive rate was higher for RIPASA (73.63%) than for Alvarado (50.55%). Conclusion There was a significant difference between the mean scores in Alvarado and RIPASA inpatients with scores suggestive of appendicitis and no appendicitis. Diagnostic accuracy was higher in RIPASA scoring compared to ALVARDO scoring. There was a significant statistical difference between the two scoring systems. When it comes to diagnosing in low-resource countries the study recommends a combination of Alvarado and RIPASA scoring systems.

A Novel Deep Learning Approach for the Automatic Diagnosis of Acute Appendicitis.

Background: Acute appendicitis (AA) is a major cause of acute abdominal pain requiring surgical intervention. Approximately 20% of AA cases are diagnosed neither early nor accurately, leading to an increased risk of appendiceal perforation and postoperative sequelae. AA can be identified with good accuracy using computed tomography (CT). However, some studies have found that a false-negative AA diagnosis made using CT can cause surgical therapy to be delayed. Deep learning experiments are aimed at minimizing false-negative diagnoses. However, the success rates reported in these studies are far from 100%. In addition, the methods used to divide patients into groups do not adequately reflect situations in which accurate radiological diagnosis is difficult. Therefore, in this study, we propose a novel deep-learning approach for the automatic diagnosis of AA using CT based on establishing a new strategy for classification according to the difficulties encountered in radiological diagnosis. Methods: A total of 266 patients with a pathological diagnosis of AA who underwent appendectomy were divided into two groups based on CT images and radiology reports. A deep learning analysis was performed on the CT images and clinical and laboratory parameters that contributed to the diagnosis of both the patient and age- and sex-adjusted control groups. Results: The deep learning diagnosis success rate was 96% for the group with advanced radiological findings and 83.3% for the group with radiologically suspicious findings that could be considered normal. Conclusions: Using deep learning, successful results can be achieved in cases in which the appendix diameter has not increased significantly and there is no significant edema effect.

Accurate diagnosis of acute appendicitis in the emergency department: an artificial intelligence-based approach.

The diagnosis of abdominal pain in emergency departments is challenging, and appendicitis is a common concern. Atypical symptoms often delay diagnosis. Although the Alvarado score aids in decision-making, its low specificity can lead to unnecessary surgeries. By leveraging machine learning, we aim to enhance diagnostic accuracy by predicting appendicitis and distinguishing it from other causes of abdominal pain in the emergency department. Data were collected from 534 patients who presented with acute abdominal pain. Patient characteristics, laboratory results, and causes of pain were recorded. Machine learning algorithms (support vector classifier, random forest classifier, gradient boosting classifier, and Gaussian naive Bayes) were used to predict the cause of pain. Model calibration was assessed using the Brier score. The mean age was 46.89 (20.3) years, with an almost equal sex distribution (49% male, 51% female). Cholecystitis was the most prevalent outcome (37.07%), followed by appendicitis (25.84%). The Gaussian naive Bayes model exhibited superior performance in terms of accuracy (95.03% 95% CI 90.44-97.83%), sensitivity (87.18% 95% CI 72.57-95.70%), and specificity (97.54% 95% CI 92.98-99.49%), while the random forest model showed a sensitivity of 79.49%, specificity of 96.72%, and accuracy of 92.55%. The gradient boosting algorithm achieved a sensitivity, specificity, and accuracy of 89.74%, 95.90%, and 94.41%, respectively. The support vector classifier demonstrated a sensitivity of 89.74%, specificity of 92.62%, and accuracy of 91.93%. The use of modern machine learning methods aids in the accurate diagnosis of appendicitis.

The Association of Isolated Cecal Necrosis Symptoms with Acute Appendicitis: A Case Report

We report a case of isolated cecal necrosis (ICN) associated with acute appendicitis in a geriatric patient in order to underline the didactic, diagnostic and therapeutic interest. This was a 70-year-old widowed female farmer living in a rural area who presented with localized abdominal pain in the right iliac fossa. The diagnosis of acute appendicitis was made. A Mac Burney incision approach revealed ICN and an inflamed appendix. The patient had an ileostomy and a partial cecal necrosectomy with an epiploic patch. A digestive fistula occurred on postoperative Day 60. The patient was transferred to a more technical center where she had a right hemicolectomy with latero-lateral ileocolic anastomosis. The prognosis was poor. The patient died 4 days later in respiratory distress.

A Case of Acute Appendicitis Complicated by Necrotizing Fasciitis Requiring Abdominal Wall Reconstruction

Acute appendicitis represents one of the most common causes of acute abdomen that may warrant emergency surgery. Necrotizing fasciitis complicated by acute appendicitis is considered a rare complication with life-threatening implications. A 65-year-old man presented with abdominal pain, where a scan, revealed a perforated appendicitis complicated by an anterior abdominal wall collection. He underwent percutaneous drainage, but subsequently developed extensive necrotizing fasciitis requiring extensive debridement and reconstruction. The rapid progression of necrotizing fasciitis calls for early recognition and prompt intervention. The key management principles employed were broad spectrum antibiotics and aggressive surgical debridement. This case demonstrated the use of vacuum-assisted closure dressing and multidisciplinary care in wound healing and coverage. To ensure early diagnosis and intervention for acute appendicitis complicated by necrotizing fasciitis, a high degree of clinical suspicion and awareness of this complication is required.

Pediatric Modification For Alvarado Score: Appearance Of Patients With Apandisitis

ABSTRACT Objective: This study, with the purpose of decreasing the morbidity rate in emergency pediatric surgery clinics, evaluates the reliability of an acute appendicitis diagnosis score we define as “appearance of the patient with appendicitis (APA)”, which is a new modification of Alvarado Score (AS). Methods: One hundred eighty patients, that admitted to Van Training and Research Hospital between February 2018 and June 2018 and were consulted to pediatric surgery with acute appendicitis suspicion; were analyzed as a randomized prospective study. In the new scoring system which we define as APA, instead of a left shift of neutrophils – a state of the patients lying still in the bed, reluctant to speak, with dry lips, with tired eyes, upset and with a troubled expression at the face is placed. For all the patients, AS (AS 1-4, AS 5-6 and AS 7-10) and APA (APA 1-4, APA 5-6 and APA 7-10) scores were independently calculated as three groups and were compared to each other. Results: 180 children (108 males – 72 female) with an average age of 11 (range, 6 – 15) were included in the study. Distribution of patients in the three groups of AS was determined as 1-4: 90 (50%), AS 5-7: 48 (26.7%) and AS 8-10: 42 (23.3%) respectively. Distribution of patients with respect to APA score were as APA 1-4: 72 (40%), APA 5-7: 69 (38.3%) and APA 8-10: 39 (21.7%). Appendectomy was performed on 3 patients from the AS 1-4 group, on 15 patients from AS 5-6 group and on 33 patients from AS 7-10 group. Whereas none of the patients from the APA 1-4 group had an appendectomy, 18 patients from APA 5-6 group and 33 patients from APA 7-10 group had an appendectomy. Conclusion: By means of the APA which we define as a combination of AS and clinical judgment (CJ), the number of pediatric cases with appendicitis suspicion to be kept under observation was increased and unnecessary –too early or too late- surgical intervention incidence was decreased. Our study shows CJ and scoring systems are not alternative methods for each other and collective use of both can decrease morbidity and mortality in acute appendicitis treatment.

Validation of the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system for the diagnosis of acute appendicitis among Ethiopian patients: a multi-institutional observational study

BackgroundAcute appendicitis is the most common surgical emergency in Ethiopian clinical practice. Although a multitude of scoring systems have been used in clinical practice, none have been universally validated. The purpose of this study was to validate the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system in the Ethiopian context.MethodsA total of 315 consecutive patients who presented with a presumptive diagnosis of acute appendicitis and were planned to undergo appendectomy were studied. All the studied patients had diagnostic sonography and underwent the RIPASA scoring system. The sensitivity, specificity, positive predictive value, and negative predictive value of RIPASA and ultrasound results with intraoperative gross examinations.ResultsThe mean age of the participants was 27.4 ± 11.5 years, with a male-to-female ratio of 1.6:1. The concordance between ultrasound and RIPASA for the diagnosis of acute appendicitis was 93.6%. The sensitivity, specificity, positive predictive value, and negative predictive value of RIPASA were 96.2%, 30.8%, 93.9%, and 42.1%, respectively. Similarly, the sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound were 95.3%, 27.8%, 95.6%, and 26.3%, respectively. White cell count and RIPASA scores were weakly correlated with intraoperative stages of acute appendicitis, r(313) = 0.18, p = 0.001, and r(313) = 0.129, p = 0.022, respectively. The rate of a negative appendectomy was 6%.ConclusionRIPASA and ultrasound had equivalent performance in the diagnosis of acute appendicitis. In both cases, the rate of negative appendectomy was low enough to validate RIPASA for clinical practice in low-income institutions where sonographic diagnosis by a conventionally trained radiologist is not available.

Ultrasound and clinical features for differential diagnosis of low-grade appendiceal mucinous neoplasm and acute suppurative appendicitis.

To investigate the application of ultrasound along with clinical features for the differential diagnosis of low-grade appendiceal mucinous neoplasm (LAMN) and acute suppurative appendicitis (ASA). The ultrasound and clinical data of 76 patients with histopathologically confirmed LAMN (31 patients) and ASA (45 patients) were retrospectively analyzed. Univariate analysis and binary logistic regression analysis of the influencing factors were conducted to identify LAMN and ASA. The AUROC was calculated to analyze the diagnostic efficacy of these independent factors. A four-grid table was established to determine the diagnostic efficacy of the ultrasound marks for diagnosing LAMN. Patient age and appendix short diameter in the LAMN group were found to be significantly higher than those in the ASA group. The neutrophil ratio and thickness of the appendix wall in the LAMN group were significantly lower than they were in the ASA group. Patient age (OR=1.112, p=0.015) and appendix short diameter (OR=1.476, p=0.008) were independent risk factors for LAMN. The AUROCs for age and short diameter were 0.898 [95% CI: 0.807, 0.956] and 0.953 [95% CI: 0.879, 0.988], respectively. The LAMN group tumors were characterized by the appearance of an "onion skin" sign or a purely cystic mark on sonograms, with specificities of 100% for both. Neutrophil ratio (OR<0.001, p=0.064) and thickness of the appendix wall (OR=0.776, p=0.414) were not independent risk factors for ASA. Employing ultrasonography with clinical features is useful for distinguishing LAMN from ASA. Patient age, short diameter of the appendix, and sonographic appearance of "onion skin" or purely cystic mark could be key factors in diagnosing LAMN.

Uncomplicated appendicitis at Herat Regional Hospital: limited resource is not always the end of the world.

Acute appendicitis is the most common aetiology of acute abdomen in children. Our aim is to describe the accuracy of diagnosis, and complications in a limited resources setting in children between 5 and 14 years old at the only tertiary referral hospital in the West region of Afghanistan. A retrospective study for a period of 1 year (21 March 2015-20 March 2016). Data was collected from patients' files. Data were analysed by epi info 7. We identified 774 children who had appendectomies at Herat Regional Hospital during the study period with complete records available for analysis. The median age was 11 years [5-14]. The rate of positive appendectomy was 87%. 72% of appendectomies were done within 24 h of the onset of symptoms. Of 675 positive appendectomies, the most common clinical features were migratory abdominal pain (90%), nausea/vomiting (80%), RLQ tenderness (90%), and rebound tenderness (81%). Among the 99 negative appendectomies, the most common signs and symptoms were anorexia 68%, nausea/vomiting 59%, RLQ tenderness 79%, and rebound tenderness 43%. 98% of positive and 71% of negative appendectomies had elevated WBC count. Post appendectomy complications occurred in 9% of our patients mostly commonly intra-abdominal abscesses (5%). Although the diagnosis of acute appendicitis is challenging in children and may involve sophisticated imaging techniques, in many settings these are unavailable. Classical manifestations such as migratory abdominal pain, abdominal tenderness, nausea, and simple lab tests play a crucial role in the diagnosis of acute appendicitis in low resource environments.

Diagnosis and treatment of acute appendicitis in patients with the new coronavirus infection COVID-19

Diagnosis and treatment of acute appendicitis in patients with the new coronavirus infection COVID-19

Diagnostic value of systemic immune inflammation index in acute appendicitis and complicated appendicitis in pregnant patients.

Acute pain in the right lower quadrant during pregnancy is difficult to approach and acute appendicitis must be excluded. The complication rate in pregnant acute appendicitis increases as a result of delayed diagnosis due to physiological and anatomic changes. The systemic immune inflammatory index (SII), which includes several inflammatory tests, is considered to be a good indicator of acute inflammation. The aim of the present study was to investigate the diagnostic value of SII in the diagnosis of acute appendicitis and complicated appendicitis in pregnant women. This was designed as a retrospective, single-center case-control study. This study was performed in pregnant women over 12 weeks of gestation who were diagnosed with acute appendicitis as indicated by pathology report and met the inclusion criteria. Vital parameters, demographic characteristics, laboratory values, presence of complicated appendicitis, and pathology reports were taken into analysis. The present study was performed with 76 pregnant women, including 38 pregnant women with acute appendicitis and 38 pregnant women with healthy controls. SII had a sensitivity of 82.0% and specificity of 66.7% with a cut-off value of 840.13 in pregnant acute appendicitis cases (AUC: 0.790; 95% CI: 0.686-0.984; p < 0.001) and SII level was significantly higher in complicated appendicitis cases with a sensitivity and specificity of 66.7% and 91.3%, respectively, with a cut-off value of 2301.66 (AUC: 0.812; 95% CI: 0.665-0.958; p = 0.001). SII is a cost-effective, rapid, easily calculated, and powerful marker that can be used for the diagnosis of both acute and complicated appendicitis in pregnant patients.

Construction of a clinical prediction model for complicated appendicitis based on machine learning techniques

Acute appendicitis is a typical surgical emergency worldwide and one of the common causes of surgical acute abdomen in the elderly. Accurately diagnosing and differentiating acute appendicitis can assist clinicians in formulating a scientific and reasonable treatment plan and providing high-quality medical services for the elderly. In this study, we validated and analyzed the different performances of various machine learning models based on the analysis of clinical data, so as to construct a simple, fast, and accurate estimation method for the diagnosis of early acute appendicitis. The dataset of this paper was obtained from the medical data of elderly patients with acute appendicitis attending the First Affiliated Hospital of Anhui University of Chinese Medicine from January 2012 to January 2022, including 196 males (60.87%) and 126 females (39.13%), including 103 (31.99%) patients with complicated appendicitis and 219 (68.01%) patients with uncomplicated appendicitis. By comparing and analyzing the prediction results of the models implemented by nine different machine learning techniques (LR, CART, RF, SVM, Bayes, KNN, NN, FDA, and GBM), we found that the GBM algorithm gave the optimal results and that sensitivity, specificity, PPV, NPV, precision, recall, F1 and brier are 0.9167, 0.9739, 0.9429, 0.9613, 0.9429, 0.9167, 0.9296, and 0.05649, respectively. The GBM model prediction results are interpreted using the SHAP technology framework. Calibration and Decision curve analysis also show that the machine learning model proposed in this paper has some clinical and economic benefits. Finally, we developed the Shiny application for complicated appendicitis diagnosis to assist clinicians in quickly and effectively recognizing patients with complicated appendicitis (CA) and uncomplicated appendicitis (UA), and to formulate a more reasonable and scientific clinical plan for acute appendicitis patient population promptly.

Neutrophil- to- Lymphocyte Ratio as a Predictor of acute Appendicitis and Its Severity

Background: The Neutrophil-to-Lymphocyte Ratio (NLR) is an emerging biomarker for the diagnosis and severity assessment of acute appendicitis. This study evaluates the predictive value of NLR in patients undergoing appendicectomy.

Gastroenteropancreatic neuroendocrine tumors in children and adolescents.

Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are rare in children and adolescents. Standard management of these tumors has not been well established due to their rarity in this age group. We aimed to report the clinical and pathological characteristics of patients with this rare disease followed and treated between the years 1993-2022. The medical records of patients with GEP-NETs were reviewed. Fourteen patients (11 girls, 3 boys) were diagnosed with GEP-NET. The median age was 13 (9-18) years. Tumor localization was the appendix in 12, stomach in one and pancreas in one patient. Mesoappendix invasion was detected in four patients two of whom underwent right hemicolectomy (RHC) and lymph node dissection (LND). Of those, one patient had lymph node involvement. The other two had not further operations. Somatostatin was used in one with pancreatic metastatic disease and the other with gastric disease after surgery. No additional treatment was given in other patients. All patients are under follow-up without evidence of disease at a median follow-up of 85 months (7-226 months). GEP-NETs should be considered in the differential diagnosis of acute appendicitis and in cases with persistent abdominal pain. In children, there is invariably a favorable prognosis, and additional surgical interventions other than simple appendectomies generally do not provide benefits. Mesoappendix invasion may not necessitate RHC and LND.

Evaluating Pediatric Appendicitis Score and Alvarado Scoring System for Detecting Acute Appendicitis in Pediatric Population

Abstract Background Acute appendicitis is the most common surgical condition of children. About 1 to 10% of children presenting in surgical emergencies with acute abdomen fall within the domain of acute appendicitis. In few of these cases, clinical signs and symptoms at presentation are such that acute appendicitis is a clear diagnosis while more often it is challenging for a surgeon to make a clinical diagnosis of acute appendicitis. In these circumstances, explorations reveal negative appendectomies and an organ with potential functions can be lost. Objective To evaluate the Pediatric Appendicitis Score and Alvarado Scoring System in Detecting Acute Appendicitis in Pediatric Population in terms of applicability, safety, and specificity in the diagnosis of Acute Appendicitis among the study group and to suggest improvements and/or modifications to increase the predictive values of Pediatric Appendicitis Score and Alvarado Scoring System, decrease the rates of false diagnosis or reduce costs. Methods a prospective cohort study that was conducted on 50 patients aged under 14 years admitted to pediatric surgery department in Ain Shams University Hospital within a period of 6 months with an expected diagnosis of Acute appendicitis. Each patient was subjected to a detailed medical history taking (with emphasis on The age, gender, duration of pain, complaint complaints ofabdominal pain and duration, fever, nausea-vomiting, diarrhea or constipation), Clinical examination:(right lower quadrant sensitivity,defense, rebound tenderness, percussion/ cough/ right lower quadrant sensitivity with jumping). Laboratory investigations:(complete blood count, the total white blood cell (WBC) and total neutrophil counts c-reactive protein ) and Ultrasound examination. Alvarado score as well as PAS were calculated for each patient . the results were then compared to the intra operative findings confirming or excluding the diagnosis of acute appendicitis. Results in the study group that was 38% males and 62% females with ages ranging from 3 to 14 years .Pediatric appendicitis score (PAS) was found to significantly predict acute appendicitis in the studied patients at cutoff 5.0 with sensitivity, specificity, PPV and NPV was 60.5%, 100%, 100% and 71.9% respectively (p &amp;lt; 0.001). Alvarado score can significantly predict acute appendicitis in the studied patients at cutoff 4.0 with sensitivity, specificity, PPV and NPV was 79.1%, 85.7%, 84.7% and 80.4% respectively (p &amp;lt; 0.001). Conclusion The results of this study showed the higher sensitivity of Alvarado score and more specificity of the Pediatric Appendicitis score. However, the sensitivity, specificity, PPV, and NPV of these criteria were not considered enough to confirm the diagnosis of acute appendicitis alone. There is a need for new parameters in the scoring systems. Such as including ultrasonagraphic findings and additional laboratory investigations such as CRP.

Different Recent Scoring Systems for Better Diagnosis of Acute Appendicitis

Abstract Background Acute appendicitis is one of the most common surgical emergencies, with a lifetime prevalence rate of approximately one in seven. Aim of the Work to compare RIPASA score, (AIR) score and Modified Alvarado Score widely and easily used scoring systems, in order to identify which one is the best in sensitivity, specificity, positive predictive value, negative predictive value and accuracy, So which one leads to the most accurate diagnosis of acute Appendicitis. Patients and Methods A randomized prospective study that was conducted in Ain-Shams University Hospitals. The study started in February 2022 till the number of cases is fulfilled. 50 patients presented with RT iliac fossa tenderness. Each patient was scored by the three scoring systems using history, examination, clinical labs. Results 66.0% of cases were positive confirmed histology and (34.0%) cases were negative confirmed histology. There were highly statistically significant difference between Negative Confirmed histology and Positive Confirmed histology regarding RIPASA score, (AIR) score and Modified Alvarado Score. In this study, receiver operating characteristic curve (ROC) shows that the best cut off point of Modified Alvarado Score to detect Positive Modified Alvarado Score group was found &amp;gt;5 * with sensitivity of 87.88%, specificity of 64.71%, PPV of 82.9%, NPV of 73.3% and total accuracy of 77.0%. Conclusion the Appendicitis Inflammatory Response score and Raja Isteri Pengiran Anak Saleha Appendicitis score have high discriminating powers and outperform the Modified Alvarado score. They could aid in selecting patients who require timely surgery or those who require further evaluation. Both these scores have the potential to turn out into scoring systems of choice if future research can substantiate our study findings.